乳腺癌化疗方案解读教学讲义.pptVIP

乳腺癌化疗 安徽医科大学第一附属医院肿瘤内科 陈振东 systemic therapies, based on tumor histology clinical and pathologic characteristics axillary node status hormone receptor content level of HER2/ expression metastatic disease Comorbidity age menopausal status. Patient preference systemic therapies, divided to the pure noninvasive carcinomas, which include LCIS and ductal carcinoma in situ (DCIS) (stage 0); operable, locoregional invasive carcinoma (clinical stage I, stage II, and some stage IIIA tumors); inoperable locoregional invasive carcinoma (clinical stage IIIB, stage IIIC, and some stage IIIA tumors); metastatic or recurrent carcinoma (stage IV). Bilateral diagnostic mammography should be performed to identify the presence of multiple primary tumors and to estimate the extent of the noninvasive lesion. The goal of treatment of in situ carcinomas is either preventing the occurrence of invasive disease or diagnosing the invasive component. Ⅰ,ⅡA,ⅡB期, :分期手段 外周血常规 肝功能 胸部X线检查 双侧X线摄片 乳房MRI，如果需要: 乳腺B超，骨ECT 腹部影像学检查（ T3N1M0) 激素受体 HER2/neu（估价预后及蒽环类抗生素、Herceptin疗效，2B） Ⅰ,ⅡA,ⅡB期:治疗 保乳与根治效果相同(1级) 腋淋巴结阴性,HER2/neu阳性,蒽环类抗生素为主方案化疗(2B级) HER2/neu假阳性需要重视 IHC或FISH检测 HER2/neu优劣尚不清楚，倾向于后者优于前者 化疗完成后放疗。放疗可以和CMF同时，但放疗期间不用MTX，或至多不超过2 个疗程(影响保乳的美容效果) 肿瘤较大的ⅡA,ⅡB及T3N1M0：术前化疗 确诊要用粗针穿剌活检，可以在瘤床预置钉以便日后手术 目标在于保留乳房 对于 Ⅱ期乳腺癌, 尚无证据表明术前化疗比术后化疗有生存优势 化疗一般为四个周期 如果多周期术前化疗无效，应立即手术 肿瘤较大的ⅡA,ⅡB及T3N1M0：术前内分泌治疗 demonstrate that the use of either anastrozole or letrozole alone provide superior rates of breast conserving surgery and usually objective response. adjuvant endocrine therapy in postmenopausal women with early breast cancer aromatase inhibitors either as initial adjuvant therapy, sequentially following 2-3 years of tamoxifen, or as extended therapy following 4.5 - 6 years of tamoxifen. aromatase inhibitors are not active in the treatment of women with functioning ovaries. adjuvant endocrine therapy The Arimidex, Tamoxifen, Alone or in Combination Trial (ATAC Trial) demonstrates that anastrozole is sup